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OVERVIEW

What is colorectal cancer?

Colorectal cancer starts in the colon or the rectum (the largest part of the intestine located near the anus). Because they share common features, these two cancers are often referred to as colorectal cancer. Cancers start when cells in your body grow quickly in an abnormal way.

When colorectal cancer is discovered early, it’s usually treatable and not life threatening. However, it can lead to death if found too late to be treated.

SYMPTOMS

What are the signs and symptoms of colorectal cancer?

The primary symptom of colorectal cancer is a polyp (growth) in the lining of your colon or rectum. If you have one, you may not even know. Polyps can only be seen with a special camera during a colonoscopy. Some polyps aren’t harmful, but some can become cancerous.

Once a polyp develops, it may lead to the following symptoms:

• Bleeding from your rectum
• Blood in your stool or in the toilet after you have a bowel movement
• A change in the shape or consistency of your stool (such as diarrhea or constipation lasting several weeks)
• Stomach cramps
• A feeling of discomfort or an urge to have a bowel movement when there is no need to have one
• Weakness or fatigue
• Unintended weight loss

Other conditions can cause these same symptoms. You should contact your healthcare provider to find what is causing your symptoms.

CAUSES & RISK FACTORS

What causes colorectal cancer?

There are several things that can increase your risk for colorectal cancer. These include:

• Age (especially over 50).
• Ethnicity.
• Prior history of polyps.
• Family history of colorectal cancer.
• Inflammatory Bowel Disease (IBD), including ulcerative colitis and Crohn’s disease.
• Inherited genetic syndromes (Lynch syndrome, Peutz-Jeghers syndrome).
• Poor diet, specifically a low-fiber, high-fat diet.
• Lack of exercise.
• Type 2 diabetes.
• Obesity.
• Smoking.
• Excessive alcohol.
• Previous radiation treatment for cancer.

Contact your family healthcare provider to decide which screening tests you should have and how often you should be screened. If you don’t have any risk factors for colorectal cancer, you will probably have your first screening test around 50 years of age.

DIAGNOSIS & TESTS

How is colorectal cancer diagnosed?

Colorectal cancer is diagnosed through several methods.

Routine screening tests can find polyps or cancers before they are large enough to cause symptoms. This is when the cancer can be more effectively treated.

If you have symptoms, your healthcare provider may perform a digital rectal exam. In this exam, your healthcare provider will put their gloved finger into your rectum to feel for growths. It’s not painful. However, it can be uncomfortable. Additional tests might include:

• Barium Enema. For this test, you are given an enema (injection of fluid into the rectum) with a liquid that makes your colon show up on an X-ray. Your healthcare provider looks at the X-ray to find abnormal spots in your entire colon. If you have an abnormal spot or if the radiologist detects polyps in your colon, your healthcare provider will probably want you to have colonoscopy.
• Fecal Occult Blood Test. This test checks your stool for blood that you can’t see. Your healthcare provider gives you a test kit and instructions to use it at home. Then you return a stool sample to your healthcare provider for testing. If blood is found, another test is done to look for a polyp, cancer or another cause of bleeding.
• Stool DNA Test. This test checks your stool for cells that are shed by colon cancers or precancerous polyps. If your test turns out positive, your healthcare provider will probably want you to have a screening test called colonoscopy.
• Before you have this test, you are given a medicine to make you relaxed and sleepy. A thin, flexible tube connected to a video camera is put into your rectum, which allows your healthcare provider to look at your entire colon. The tube can also be used to remove polyps and cancers during the exam. Colonoscopy may be uncomfortable, but it is usually not painful.
• Virtual Colonoscopy. This is a new test that uses a computerized tomography (CT) machine to take pictures of your colon. Your healthcare provider can then see all of the images combined in a computer to check for polyps or cancer. If your healthcare provider finds polyps or other abnormalities in your colon, you will need to have a traditional colonoscopy to examine them in more detail or to remove them.
• Flexible Sigmoidoscopy. In this test, your healthcare provider puts a thin, flexible, hollow tube with a light on the end into your rectum. The tube is connected to a tiny video camera so the healthcare provider can look at the rectum and the lower part of your colon. This test can be a bit uncomfortable, but it lets your healthcare provider see polyps when they are very small (before they can be found with a fecal occult blood test). Because flexible sigmoidoscopy may miss cancerous polyps that are in the upper part of the colon, some healthcare providers prefer a colonoscopy. Your healthcare provider will discuss these options with you.

Both Nova Scotia and Prince Edward Island offer screening tests for colorectal cancer called the Fecal Immunochemical Test (FIT).  This is offered to average risk people between the ages of 50 and 74, every 2 years.  The test can be done at home as per the kit instructions.  Those with abnormal results will be contacted for follow up.  For more information, see the For More Information Section below.

PREVENTION

Can colorectal cancer be prevented or avoided?

Colorectal cancer can’t be prevented or avoided. However, you can reduce your risk by choosing a healthy diet and exercising. Also, lose weight, quit smoking, and reduce the amount of alcohol you drink. Genetics tests can tell you if you carry an inherited gene that increases your risk of colorectal cancer. Discuss this option with your healthcare provider.

TREATMENT

 If you have colorectal cancer, your healthcare provider will talk to you about treatment options. These include:

• This is usually the main treatment for colon and rectal cancer. It removes the tumor.
• This is treatment with drugs that kill cancer cells that may have been left behind after a tumor is removed by surgery. It’s often used when there is a risk the colon or rectal cancer will come back. Sometimes chemotherapy can be used before surgery to shrink the size of a tumor.
• Also known as radiation, this treatment uses high powered X-rays to kill cancer cells. Radiation therapy can be used in many ways. Radiation may be used either before or after surgery for rectal cancer. Sometimes both radiotherapy and chemotherapy are used after surgery.
• Targeted therapy. These are drugs that attack the type of cancer cells you have. This treatment is used for advanced colon cancer

Cancer treatment affects people differently. Cancer treatment affects people differently. Some people have few or no side effects. However, many people feel very sick.

Living with colorectal cancer

Living with colorectal cancer can cause fear and discomfort, depending on the stage of your cancer. If you were treated successfully and are cancer free, you’ll be required to have regular screenings the rest of your life

FOR MORE INFORMATION

Nova Scotia Colon Cancer Prevention Program
Toll Free 1-866-599-2267
https://www.nshealth.ca/service-details/Colon%20Cancer%20Prevention%20Program

Prince Edward Island Colorectal Cancer Screening Program (including at home screening test)
Toll Free 1-888-561-2233
https://www.princeedwardisland.ca/en/information/health-pei/colorectal-cancer-screening-program

Canadian Cancer Society at:
Toll Free 1-888-939-3333
www.cancer.ca/en

Colorectal Cancer Canada
Toll Free 1-877-502-6566
https://www.colorectalcancercanada.com/